Introduction

It is vital to ensure standardization and objective feedback during training and skill acquisition for optimal surgical outcomes and patient safety. We aimed to develop a structured scoring tool: CASE (Cystectomy Assessment & Surgical Evaluation) that objectively measures and quantifies performance during radical cystectomy (RC) for men.

Methods

A multinational expert panel (11 Surgeons who perform open and/or robot-assisted radical cystectomy) collaborated towards development and content validation of the male RC scoring. The critical steps were deconstructed into 9 key domains, where each domain was assessed by 5 anchors evaluating surgical principles, technical proficiency and safety. Content validation was done utilizing the Delphi methodology. Each anchor statement was assessed in terms of 3 aspects: contextual relevance, concordance between language and anchor score, and clarity of wording. An independent coordinator collated the comments and computed Content Validity Index (CVI) for each aspect of each anchor. If CVI was >=0.75, consensus was reached and the statement was removed. If consensus was not achieved, the coordinator incorporated comments from the panel and the updated scoring system was redistributed. This process was repeated until consensus was achieved for all statements. Experts were blinded to each other's assessment.

Results

The expert panel reached consensus after 4 rounds on all aspects. A ninth domain assessing Disposition of Tissue was removed from the system after the second round. CVI >= 0.75 was achieved in 8 (11%) statements in the first round, 44 (61%) statements in the second, 17 (24%) statements in the third and 3 (4%) statements in the 4th round. The final 8 domains included: Pelvic Lymph Node Dissection, Development of the Peri-ureteral Space, Lateral Pelvic Space, Anterior Rectal Space, Control of the Vascular Pedicle, Anterior Vesical Space, Control of the Dorsal Venous Complex, and Apical Dissection (Fig 1).

Conclusions

We developed and validated a scoring system for RC that can provide structured feedback for surgical quality assessment, training and feedback. Validation of the scoring system is in process.

Funding

Roswell Park Alliance Foundation